GLAUCOMA FOLLOWING CHILDHOOD CATARACT-SURGERY

Glaucoma has been recognized as an infrequent but serious complication following surgery for congenital and acquired cataracts in childhood. Little is known concerning the influence of factors on the risk of gl aucoma such as age at surgery, type of cataract, associated ocular abn ormalities, and type of surgery. We reviewed records of 240 eyes of 15 5 patients on whom cataract surgery had been performed between January 1965 and July 1990 at Children's Hospital, Boston. After excluding th ose patients who had been followed up less than 5 years after surgery, and those who had had surgery after the age of 10 years, 125 eyes of 82 patients were included in the study group. We identified 14 eyes of 9 patients that had developed open-angle glaucoma 5.3 to 13.1 years f ollowing surgery (average 7.4 years). An additional 4 eyes of 3 patien ts developed angle closure glaucoma, which was diagnosed at 146, 177, 2911, and 2939 days following surgery. A fifth patient developed acute angle closure 1.7 years following primary cataract surgery and 53 day s following secondary discission. All but one of the patients who deve loped glaucoma had cataract surgery at less than 1 year of age. Age at surgery for the entire study group averaged 1.9 years, and ranged fro m 25 days to 9.6 years. We conclude that patients having cataract surg ery before 1 year of age are at the greatest risk of developing postop erative open-angle glaucoma. Additional increased relative risk was fo und in eyes with microcornea, congenital rubella syndrome, and poor pu pillary dilation with 1% cyclopentolate (Cyclogyl). No significant dif ference was seen among the various surgical methods of cataract remova l.